What are the effects of a chemical burn from Listerine (benzalkonium chloride) to the posterior oral cavity?

From the Guidelines

If you've experienced a chemical burn from Listerine in the back of your mouth, immediately rinse your mouth thoroughly with cool water for several minutes to dilute and remove the mouthwash, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. This is crucial in reducing the extent of the injury, as the key to first aid in caustic injuries is rapid removal of the caustic agent 1. Some key points to consider when treating a chemical burn from Listerine include:

• Rinsing the mouth with cool water to dilute the mouthwash
• Taking over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) according to package directions to manage discomfort
• Avoiding spicy, acidic, hot, or rough foods that could further irritate the area
• Temporarily switching to an alcohol-free mouthwash or using salt water rinses (1/2 teaspoon salt in 8 ounces warm water) several times daily It's also important to note that most chemical burns from mouthwash heal within 7-10 days, but if you experience severe pain, difficulty swallowing, significant swelling, pus formation, or if symptoms worsen or don't improve after 3-4 days, you should seek medical attention 1. Additionally, it's worth mentioning that Listerine contains alcohol and other antiseptic compounds that can cause tissue irritation, especially if used at full strength or for too long, but most burns are superficial and heal without complications 1. In general, the management of chemical burns prioritizes the removal of the caustic agent, irrigation with water, and avoidance of further irritation, as outlined in the 2024 American Heart Association and American Red Cross guidelines for first aid 1.

From the Research

Chemical Burns

• Chemical burns can cause deep injury and significant scarring to the skin, and the mechanism and pathophysiology of chemical burns is distinct to thermal burns 2
• The recommended first aid approaches for chemical burns are different from thermal burns, and immediate water lavage for 60 min is an effective first aid measure to improve outcomes after chemical burns to the skin 2

Management of Chemical Burns

• Prompt assessment and management of chemical injuries is vital to reduce the deleterious effect of the compound involved 3
• Understanding the pathophysiology of a chemical burn injury and identifying the nature of the offending agent is important for effective management 3
• Chemical burns can be caused by corrosive agents (acids and alkali) leading to extensive tissue damage 3

Specific Considerations for Chemical Burns

• Acids caused 26% of all chemical burns and alkalis caused 55% in one study 4
• The hand and upper extremity are the most frequently involved parts of the body in chemical burns, and these injuries may lead to severe temporary or permanent loss of function 5
• Exposure to certain chemicals carries the risk of substantial systemic toxicity and even mortality 5

First Aid for Chemical Burns

• Twenty minutes of cool running water is an effective first aid measure to improve outcomes after thermal burn, but for chemical burns to the skin, the recommendations are immediate water lavage for 60 min 2
• Removal of contaminated clothing if not stuck to the skin and then covering the wound with a sterile dressing is also recommended 2
• The early application of cool water irrigation may reduce length of hospital stay and the extent of scarring 2